The influence of meaning in life and depression in multiple sclerosis

Catarina Ramos Pinto, Marina Guerra


This study aims to analyze the influence of meaning in life, social support, anxiety and depression in the quality of life of people with Multiple Sclerosis (MS). A sample of 30 individuals with a confirmed medical diagnosis, being 56.7% women and with an average age of 48.17 years, answered the following instruments: socio-demographic and clinical questionnaire; Meaning in Life Scale; Portuguese version of the Instrumental-Expressive Social-Support ScaleHADS and WHOQOL-Bref. The regression model pointed out the following determinants for the different quality of life domains: for the General facet and Social Relations domain, the Depression; for the Physical domain, Depression and Phenotypes of MS; and for the Psychological and Environmentdomains the Meaning in Life and Anxiety. This study points out the relevance of psychological intervention in the improvement of quality of life in MS and, in particular, the importance of the reduction of anxious and depressive symptomatology and rediscovery of the meaning in life.


Quality of life, Multiple sclerosis, Anxiety, Depression, Meaning in life, Social support.


Aarseth, J. H., Beiske, A. G., Czujko, B., Myhr, K. M., Pedersen, E. D., Sandanger, I., & Svensson, E. (2008). Depression and anxiety amongst multiple sclerosis patients. European Journal of Neurology, 15, 239-245. doi: 10.1111/j.1468-1331.2007.02041.x

Abreu, P., Guimarães, J., Mendonça, M. T., & Sá, M. J. (2012). Esclerose múltipla: Epidemiologia, etiopatogenia, fisiopatologia e diagnóstico diferencial. Sinapse – Publicação da Sociedade Portuguesa de Neurologia, 12, 5.

Aghababian, V., Auquier, P., Baumstarck-Barrau, K., Klemina, I., Pelletier, J., Reuter, F., & Simeoni, M. C. (2011). Cognitive function and quality of life in multiple sclerosis patients: A cross-sectional study. BMC Neurology, 11, 17. doi: 10.1186/1471-2377-11-17

American Psychiatric Association [APA]. (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.

Andersen, B. L., Golden-Kreutz, D., Jim, H. S., Purnell, J. Q., & Richardson, S. A. (2006). Measuring meaning in life following cancer. Quality of Life Research, 15, 1355-1371. doi: 10.1007/s11136-00-6-0028-6

Asenbaum, S., Klösch, G., Kollegger, H., Kristoferitsch, W., Lobentanz, I. S., Sauter, C., . . . Zeitlhofer, J. (2004). Factors influencing quality of life in multiple sclerosis patients: Disability, depressive mood, fatigue and sleep quality. Acta Neurologica Scandinavica, 110, 6-13. doi: 10.1111/j.1600-0404.2004.00257.x

Asiret, G. D., & Özdemir, L. (2011). A holistic look at patients with multiple sclerosis: Focusing on social life, household and employment issues. Turkish Journal of Physical Medicine & Rehabilitation, 57, 19-24. doi: 10.4274/tftr.57.04

Bakshi, R., & Janardhan, V. (2002). Quality of life in patients with multiple sclerosis: The impact of fatigue and depression. Journal of the Neurological Sciences, 205, 51-58.

Bambara, J. K., Haselkorn, J. K., Turner, A. P., & Williams, R. M. (2011). Perceived social support and depression among veterans with multiple sclerosis. Disability and Rehabilitation, 33, 1-8. doi: 10.3109/09638288.2010.481026

Baudo, S., D’Alisa, S., Mauro, A., Miscio, G., Simone, A., & Tesio, L. (2006). Depression is the main determinant of quality of life in multiple sclerosis: A classification-regression (CART) study. Disability and Rehabilitation, 28, 307-314. doi: 10.1080/09638280500191753

Baumeister, R. F., & Vohs, K. D. (2002). The pursuit of meaningfulness in life. In S. J. Lopez & C. R. Snyder (Eds.), Handbook of positive psychology. New York: Oxford University Press.

Baumstarck, K., Boyer, L., Boucekine, M., Michel, P., Pelletier, J., & Auquier, P. (2013). Measuring the quality of life in patients with multiple sclerosis in clinical practice: A necessary challenge. Multiple Sclerosis International. Retrieved from

Beard, S. M., Richards, R. G., Sampson, F. C., & Tappenden, P. (2002). A review of the natural history and epidemiology of multiple sclerosis: Implications for resource allocation and health economic models. Health Technology Assessment Journal, 6, 1-73.

Becho, J., De Sá, J., Marques, J., Mendes, H., Paulos, A., & Roxo, J. (2006). The prevalence of multiple sclerosis in the District of Santarém, Portugal. Journal of Neurology, 253, 914-918.

Benito-León, J., González, J. M. M., Mitchell, A. J., & Rivera-Navarro, J. (2005). Quality of life and its assessment in multiple sclerosis: Integrating physical and psychological components of wellbeing. Lancet Neurology, 4, 556-566. doi: 10.1016/S1474-4422(05)70166-6

Berres, M., Ehrensperger, M. M., Grether, A., Kappos, L., Monsch, A. U., Romer, G., & Steck, B. (2008). Neuropsychological dysfunction, depression, physical disability, and coping processes in families with a parent affected by multiple sclerosis. Multiple Sclerosis, 14, 1106-1112. doi: 10.1177/1352458508093678

Calheiros, J., Costa, D., & Sá, M. (2012). The effect of social support on the quality of life of patients with multiple sclerosis. Arquivos de Neuro-Psiquiatria, 70, 108-113.

Chen, K., Fan, Y., Hu, R., Li, K., & Yang, T. (2013). Impact of depression, fatigue and disability on quality of life in Chinese patients with multiple sclerosis. Stress and Health: Journal of the International Society for the Investigation of Stress, 29, 108-112. doi: 10.1002/smi.2432

Christopoulos, A. L., Kitsos, D. K., Poulios, A., & Voumvourakis, K. I. (2013). Mental health issues in multiple sclerosis patients and healthy controls and their association with disease related factors. International Neuropsychiatric Disease Journal, 1, 104-112.

Colinet, S. (2013). The ‘career’ of people with multiple sclerosis: Three key moments. The start of the disease to the ‘biographical work’. Revista Española de Investigaciones Sociológicas, 144, 127-138.

Dahl, O.-P., Lydersen, S., Midgard, R., & Stordal, E. (2009). Anxiety and depression in multiple sclerosis. A comparative population-based study in Nord-Trøndelag County, Norway. Multiple Sclerosis (Houndmills, Basingstoke, England), 15, 1495-1501. doi: 10.1177/1352458509351542

Dajić, V., & Tadić, D. (2013). Quality of life in patients with multiple sclerosis in Republic of Srpska. Medicinskiglasnik : Official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 10, 113-119.

DeJean, D., Giacomini, M., Vanstone, M., & Brundisini, F. (2013). Patient experiences of depression and anxiety with chronic disease: A systematic review and qualitative meta-synthesis. Ontario Health Technology Assessment Series, 13, 1-33.

DeLuca, J., & Nocentini, U. (2011). Neuropsychological, medical and rehabilitative management of persons with multiple sclerosis. NeuroRehabilitation, 29, 197-219. doi: 10.3233/NRE-2011-0695

Dezutter, J., Casalin, S., Wachholtz, A., Luyckx, K., Hekking J., & Vandewiele, W. (2013). Meaning in life: An important factor for the psychological well-being of chronically ill patients?. Rehabilitation Psychology, 58, 334-341.

Dlugonski, D., Motl, R. W., Sandroff, B., Suh, Y., & Weikert, M. (2012). Physical activity, social support, and depression: Possible independent and indirect associations in persons with multiple sclerosis. Psychology, Health & Medicine, 17, 196-206. doi: 10.1080/13548506.2011.601747

El Bejjani, M., Ghadieh, A., Habib, R., Herlopian, A., Issa, Z., Khalifa, A., & Yamout, B. (2013). Predictors of quality of life among multiple sclerosis patients: A comprehensive analysis. European Journal of Neurology: The Official Journal of the European Federation of Neurological Societies, 20, 756-764. doi: 10.1111/ene.12046

Falvo, D. (2005). Medical and psychosocial aspects of chronic illness and disability (3rd ed.). Canada: Jones & Barlett Learning.

Feinstein, A. (2002). An examination of suicidal intent in patients with multiple sclerosis. Neurology, 59, 674-678.

Feinstein, A. (2011). Multiple sclerosis and depression. Multiple Sclerosis (Houndmills, Basingstoke, England), 17, 1276-1281. doi: 10.1177/1352458511417835

Feinstein, A., & Korostil, M. (2007). Anxiety disorders and their clinical correlates in multiple sclerosis patients. Multiple Sclerosis, 13, 67-72.

Ford, D. V., Jones, K. H., Middleton, R. M., Noble, J. G., & Osborne, L. A. (2012). Commentary on ‘Disability outcome measures in multiple sclerosis clinical trials’. Multiple Sclerosis, 18, 1718-1720. doi: 10.1177/1352458512457847

Frankl, V. (1978). Psychotherapy and existentialism selected papers on Logotherapy. Middlesex: Penguins, Books.

Guerra, M. P. (1992). Conceito de auto-actualização, elaboração de uma escala e avaliação das suas qualidades psicométricas. Psychologica, 7, 95-109.

Guerra, M. P. (1995). Uma escala de avaliação de suporte social: Sua aplicação numa população seropositiva ao vírus HIV. In L. S. Almeida & I. S. Ribeiro (Eds.), Avaliação Psicológica: Formas e Contextos (pp. 25-34). Braga: APPORT.

Guerra, M. P. (2010). Humanismo revisitado e psicologia positiva: Contributos para a psicologia da saúde. Prova de agregação – Lição Dezembro, Faculdade de Psicologia e de Ciências da Educação da Universidade do Porto, Porto, Portugal.

Guerra, M. P., Lencastre, L., Silva, E., & Teixeira, P. M. (2017). Meaning in life in medical settings: A new measure correlating with psychological variables in disease. Cogent Psychology, 4. Retrieved from

Guerra, S. (2013). Management of psychosocial adjustment among people with multiple sclerosis: A critical analysis. British Journal of Neuroscience Nursing, 9, 89-92.

Janssens, A. C., van Doorn, P. A., de Boer, J. B., Kalkers, N. F., van der Meche, F. G., Passchier, J., & Hintzen, R. Q. (2003). Anxiety and depression influence the relation between disability status and quality of life in multiple sclerosis. Multiple Sclerosis, 9, 397-403.

Jim, H. S., & Andersen, B. L. (2007). Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. British Journal of Health Psychology, 12, 363-381. doi: 10.1348/135910706X128278

Jim, H. S., Purnell, J. Q., Richardson, S. A., Golden-Kreutz, D., & Andersen, B. L. (2006). Measuring meaning in life following cancer. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 15, 1355-1371. Retrieved from

Kane, R., Turner, A. P., Wallin, M. T., Wilken, J. A., & Williams, R. M. (2006). Depression and multiple sclerosis: Review of a lethal combination. The Journal of Rehabilitation Research and Development, 43, 45-61. doi: 10.1682/JRRD.2004.09.0117

Metz, L. M., Patten, S. B., Reimer, M. A., & Wang, J. L. (2000). Major depression and quality of life in individuals with multiple sclerosis. International Journal of Psychiatry in Medicine, 30, 309-317.

Pallant, J. (2011). SPSS Survival Manual. A step by step guide to data analysis using SPSS (4th ed.). Austrália: Allen & Unwin.

Ribeiro, J., Silva, I., Ferreira, T., Martins, A., Meneses, R., & Baltar, M. (2007). Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine, 12, 225-237.

Richman, S., & Schub, T. (2013). Quick lesson about... Multiple Sclerosis. Cinahl Nursing Guide, 1-3.

Sá, M. J. (2008). Psychological aspects of multiple sclerosis. Clinical Neurology and Neurosurgery, 110, 868-877.

Salehpoor, G., Rezaei, S., & Hosseininezhad, M. (2014). Quality of life in multiple sclerosis (MS) and role of fatigue, depression, anxiety, and stress: A bicenter study from north of Iran. Iranian Journal of Nursing and Midwifery Research, 19, 593-599.

Serra, A., Canavarro, M., Simões, M., Pereira, M., Gameiro, S., Quartilho, M., . . . Paredes, T. (2006). Estudos Psicométricos do Instrumento de Avaliação da Qualidade de Vida da Organização Mundial de Saúde (WHOQOL-Bref) para Português de Portugal. Psiquiatria Clínica, 27, 41-49.

Soares, M. S. (2006). Qualidade de vida e esclerose múltipla. Coimbra: Formasau – Formação e Saúde.

Sommerhalder, C. (2010). Sentido de vida na fase adulta e velhice. Psicologia, Reflexão e Crítica, 23, 270-277.

Sousa, C., & Pereira, M. G. (2008). Morbilidade psicológica e representações da doença em pacientes com esclerose múltipla: Estudo de validação da “Hospital Anxiety and Depression Scale” (HADS). Psicologia Saúde & Doenças, 9, 283-298.

Steger, M. F. (2009). Meaning in life. In C. R. Snyder & S. J. Lopez (Eds.), Oxford handbook of positive psychology (2nd ed., pp. 679-689). Oxford, United Kingdom: Oxford University Press.

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Pearson Education.

Theofilou, P. (2013). Sociodemographic and clinical determinants of quality of life and health representations in Greek patients with multiple sclerosis. Europe’s Journal of Psychology, 9, 33-50. doi: 10.5964/ejop.v9i1.387



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